Hypothermia is total body cooling, a bodily response which
occurs when the right conditions are present such as wind
exposure, wet conditions, where the body becomes very cold,
coupled with total exhaustion. Individuals usually shiver
for a period of time, then lose consciousness. Core body temperature
can then drop to life-threatening levels. Patients may appear
clinically dead, but area able to be resuscitated if handled
very carefully and properly warmed. The knowledge that these
individuals can be treated if they receive quick attention
is of critical concern to those spending time in the out of
doors, where these potential conditions could develop. Cold,
blue, stiff patients with no palpable pulse are always to
be treated as if they can be resuscitated, especially if hypothermia
appears to be the major cause. Although it may seem surprising,
it is not uncommon for individuals in Florida to become hypothermic
when swimming in the ocean, as hypothermia can occur any time
a situation is involved where core body temperature decreases.
Hypothermia can occur outside of a cold environment. The very
young and very old are more susceptible to hypothermic conditions.
A person in their 6th to 7th decade of life down in Florida,
for example, could while swimming in the ocean drop their
core body temperature to a level that could potentially induce
hypothermia.

Common signs and symptoms of depressed body temperature including
the following:

94° Fahrenheit or less

Stumbling or wide gait

Slurred speech

Shivering

Faraway gaze

Hypothermia is suspected when you see an exhausted individual
who is cold, wet, with a depressed body temperature.

Predisposing conditions

Skiing

Hiking

Trauma

Stalled cars during winter months

Alcohol/drugs can definitely incapacitate an individual,
thereby contributing to a hypothermic occurrence. Drugs
and alcohol also suppress shivering, which is very important.
Shivering acts as a heat generator for the body

Immersion or becoming wet can exacerbate a situation

Being very young or old is a contributing factor

Nutritional deprivation

Sugar depletion from the body will exacerbate hypothermia

Endocrine diseases, diabetes for example, can predispose
an individual to become hypothermic more quickly

Hypothermia Symptoms

Initial symptoms if still awake include expressed fatigue,
slurred speech, poor decision-making, muscle weakness, shivering,
an "I'm all right, I'm all right" attitude. These
individuals can rapidly deteriorate to the point they have
no respiration, no heart sounds, fixed and dilated pupils,
are cold, stiff and blue.

Hypothermia causes significant liquid volume depletion, which
limits the body's ability to shiver, and prevents exercise.
Shivering depletes sugars from the body. Subsequently sugar
and fluids need to be replaced and maintained.

In the outdoors, management of individuals demonstrating
any of the above should occur quickly. An individual recognized
as hypothermic should be offered warm, sweet drinks for liquid
volume replacement, and these warm, sweet drinks are important
to help generate heat. These individuals need to be kept dry
and insulated. Shivering is the most effective way that the
individual is going to re-warm in the out of doors.

IF A PERSON IS UNCONSCIOUS, GREAT CARE MUST
BE TAKEN NOT TO JOSTLE THE INDIVIDUAL. EVEN IF YOU ARE TAKING
OFF WET CLOTHES AND REPLACING THEM WITH DRY ONES, IT IS IMPERATIVE
THAT YOU ARE VERY GENTLE. IT HAS BEEN DOCUMENTED OVER AND
OVER THAT AN INDIVIDUAL WITH SEVERE HYPOTHERMIA CAN EASILY
DEVELOP LIFE-THREATENING HEART ARRHYTHMIAS AND DIE IF PROPER
PRECAUTIONS ARE NOT TAKEN AND JOSTLING AND QUICK MOVEMENTS
OCCUR.

Subsequently, in the outdoors, it is important for these
individuals to be handled very carefully as they are susceptible
to arrhythmias. Always look to keep the airways open and the
individual dry. No CPR until the person is in a vehicle. Apply
heat packs, bottles or pads only to the bottoms of the feet
and the palms of the hands. When you warm the skin all at
once, it suppresses shivering, which is counterproductive,
as once the shivering is suppressed, the core body temperature
will decrease even further. So in outdoor wilderness management
in the field, we do not want to stop the individual from shivering.
The patient then should be transported immediately after for
further care.

In review, it is important to be able to identify a hypothermic
individual in an outdoor situation. It is important to note
that shivering is equal to 4-5 100-watt light bulbs, as far
as generating heat. Field assessment is important to determine
how severely hypothermic an individual is. Obviously skin
and body temperature are both important; however in an outdoor
setting, measuring these might not be possible if the appropriate
tools are not available.

In a severely hypothermic individual, DO
NOT MOVE THE PATIENT. BE VERY GENTLE. The following are priorities:

Stop the individual's temperature from dropping and slowly
increase. It is important to maximize a safe warming rate.
There are many ways to do this. There are external and internal
ways to heat. In an outdoor situation, externally warming
is obviously the most practical. Some other creative ways
would be building a fire, use sleeping bags, tarps and tents
to redirect the warm air towards the victim's body. This
should be done slowly. Heating pads, if available, or simply
laying next to the victim, using another's body warmth to
warm the victim is beneficial in terms of re-warming and
increasing temperature

Remove wet clothing as gently as possible, without jostling
the torso

In the initial stages of hypothermia, exercising is not
the best way to increasing temperature since you are burning
up sugar and eventually this could be counterproductive.